Giving a baby a pacifier before bed may I r. help reduce the risk of sudden infant death syndrome (SIDS), according to a review of studies done on pacifier use. And the evidence was compelling enough for the American Academy of Pediatrics (AAP) to include a recommendation about pacifier use in its updated SIDS guidelines.

The Newest Study

Study author Dr. Fern R. Hauck, an associate professor of family medicine and public health sciences at the University of Virginia Health System in Charlottesville, and her colleagues reviewed seven studies that looked at the link between pacifier use and SIDS. They concluded that approximately one SIDS death could be prevented for every 2,733 babies if they used a pacifier while they slept.

"When we looked at the last time the baby was placed for sleep, there was a consistent protective effect for SIDS from pacifier use," says Hauck. "There was a 61% reduction in SIDS risk."

Benefit Outweighs Risk

That benefit outweighs any potential risks of pacifier use, including dental problems, a slightly increased risk of ear infections and breast-feeding difficulties, Hauck says.

Although she doesn't know why pacifier use might protect against SIDS, Hauck says there are several theories. One is that sucking on a pacifier brings the tongue forward, forcing the airway to open more. Another theory is that when babies suck on a pacifier, they may be more easily aroused from sleep.

Dr. Dan Polk, vice chairman of the division of neonatology at Children's Memorial Hospital in Chicago, says this study's findings may be reassuring to parents who already give their infant a pacifier, but they prove only an association between pacifier use and a reduced incidence of SIDS, not necessarily a cause-and-effect relationship. The findings do not prove that pacifier use can actually reduce SIDS, he says.

SIDS Guidelines

Whatever the reason for the apparent protective effect, the AAP is recommending offering infants a pacifier at bedtime and naptime for the first year of life. The pacifier doesn't need to be reinserted if it falls out during sleep, and parents should not coat the pacifier with any sweet substances to entice the baby to take it. Breast-fed infants should not be given a pacifier until breast-feeding is well-established, usually at one month, the Academy says.

Along with endorsing pacifier use, other big changes in the AAP SIDS guidelines include recommending that babies sleep in the same room as the parents, but not in the same bed, and that parents not put babies to sleep on their sides.

"There's been a lot of new information on SIDS in the past five years, which is why the committee revised the SIDS guidelines," explains Dr. Rachel Moon, a pediatrician and SIDS researcher at Children's National Medical Center in Washington DC.

Other key recommendations for preventing SIDS include...

Place infants to sleep on their backs every time they go to sleep.

Only use firm sleep surfaces and keep soft objects, such as pillows and heavy blankets, out of the baby's crib.

Give the baby a smoke-free environment both before and after pregnancy.

Don't share your bed with your baby, but if possible, keep the baby in a crib in your bedroom.

Avoid overheating your baby. Babies shouldn't feel hot to the touch. Keep the room warm enough so a lightly clothed adult would be comfortable.

The AAP committee also recommends that parents not use commercial products that are marketed as reducing the risk of SIDS. There is no evidence that such products actually provide any benefit.

Also, the committee recommends that babies be given plenty of tummy time when they are awake to avoid the development of a flat spot on the back of the head from always sleeping in the same position.

"Parents need to make sure that everyone caring for the baby is aware of the guidelines. The babysitter, the grandparents-everybody needs to know," says Moon.

"Since we don't know the cause of SIDS, the best we can do is try to control the markers," says Polk. 'Just do the best you can, but that doesn't guarantee you've eliminated the risk of SIDS," he adds.

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